I read today that the average price of an appendectomy (pause to explain - although if you don't know what this is, it's time to do some more reading - it's the the surgical removal of a person's appendix) in California is $33,000...that's the average. Apparently the price varies from hospital to hospital, and not by the amounts you might be forgiven for assuming. The report I read indicates that the prices range from $1500 (that seems pretty darned reasonable) to - wait for it...$180,000 (which seems absolutely criminal - I'd expect to have a new appendix and a dozen spares, my car fully serviced and the house professionally renovated for that kind of money). One hundred and eighty thousand dollars. In proper money; about one hundred and twenty thousand pounds sterling. By comparison, an entirely elective breast augmentation in the private sector in the UK would cost the willing patient around $7000. $33,000 versus $7,000. Life saving versus elective. Hmmmm. Are we being gouged, do ya think?

Having spent the majority of my life in a country (The United Kingdom) where health care was, to all intents and purposes, free at the point of delivery, and now living in a country (Oh! Canada) which sits closer to that end of the spectrum than at the cutthroat (pardon the surgical pun) pay-or-you-die end which has characterized the USA's so-called corporate-dominated 'system' until recently, the whole notion of the 'price' of health care has seemed rather alien to me. These days the cost is much higher for me than it ever was in the UK, and with due credit to Joni Mitchell, I do indeed now know (and retrospectively appreciate) what I had - but only now that it's gone. This is why my wheezing, addled mind turns to such matters.

A simple man as I am, I would like some simple information from the health care system: if a relatively simple operation such as an appendectomy has an average price tag of $33,000 (just as an example, and I know it's in the USA), how is that price arrived at in the facilities where it costs that much? How much does the surgeon make for that hour or two of work? What is the cost of the salaries for the theatre and post operative care staff? What is the actual cost to the medical facility of the drugs that are used? This last part is of some particular interest to me; for a while I worked in a mid/senior managerial capacity for a major pharmacy chain, and I was able to see the astonishing mark-up on regular medications. A phial of tablets, for example, that cost the patient $35 would routinely be bought in by the company at one tenth of that figure. Such margins were not unusual and across the board, with few exceptions to a massive mark-up standard.

So I wonder, when we are battered almost weekly with politicians' assertions that health care is where the majority of our taxes go, does anybody with any power ever pause and say "Hang on a minute, HOW much did you say that costs?". For that to be a worthwhile exercise, of course, there must be follow-up questions about margins and rates of pay for the surgeons, and some effort to unearth a genuine justification for the seemingly outlandish costs of health care. I have yet to see anyone really pinned down on this subject.

I believe that, among other things, our western societies have to a large extent, capitulated and handed over the purse strings to the medical profession. Doctors are paid exorbitant amounts, no matter which way you cut it (ouch; another surgical pun - sorry), and the brutal truth is that while we expect them to be infallible, they are anything but. A fairly recent American study for example, indicated that: "Misdiagnosis rates in the ICU or Emergency Department have been studied, with rates ranging from 20% to 40%.". That kind of statistic indicates to me that a group of professionals are being placed on a (very, very expensive) pedestal which may be rather too tall.

I'm not a doctor and never will be (pause for the crowd to cheer), so I speak from a position purely of intuitive common sense. Therefore, I believe the simple questions are the best: "How much does an operation cost?" Followed by "WHY?". Followed by "WHY does that drug cost as much as it does - what is it bought in at?", and including "WHY is the surgeon paid $2000 per hour?". Simple questions which I believe need to be asked and stuck to until an honest answer is obtained - otherwise the health care systems of our countries - and thus public money - will continue to be held ransom by the drug companies and the medical profession (which does so love to wrap itself in the cloak of self-righteousness).

Unfortunately, it's not as if us patients can go on strike to get better value for money, is it? I mean we could try it but we might find that the doctor's problems would just...well...die...